Itchy Feet, Ankles and Toes (With or Without Rash)

Athlete’s Foot (Tinea Pedis, Ringworm of the Foot)

Athlete’s foot refers to infection of the foot by different fungi commonly called Tinea pedis. Skin between toes, on soles, sides or upper part of the foot is usually itchy, sore, reddened, damp, and may peel off and crack (Picture 1). Athlete’s foot is common in athletes but anyone can get it. People who constantly have wet feet due to occupation, humid environment, or wearing poorly ventilated shoes are commonly affected. One can contract Tinea pedis from a public shower or gym floor or by sharing contaminated shoes.

Anti-fungal over the counter (OTC) cream or powder, or prescribed ointment or pill

10% tea tree oil cream

Raw garlic, crushed and put over affected area

Not all fungal infections of the foot are caused by Tinea pedis, so when in doubt, doctor should give you a diagnosis and prescribe appropriate anti-fungal drug.

Prevention is in keeping feet dry:

Wear cotton socks and change them daily

Dry the skin after a bath; you can use hair dryer carefully to dry the skin between the toes

Mild occasional infection should heal in few days, if feet are kept dry. People who constantly have fungal infection may need several weeks or months to cure it though.

Cutaneus Larva Migrans (Creeping Eruption, Ground Itch, Sandworms)

Cutaneous larva migrans is an immature form of various parasitic intestinal worms often found in feces of cats, dogs or other animals. Confined mostly to tropical and subtropical areas (central and south US, Central and South America, Australia), it can be contracted by skin contact with moist soil or sand, usually by walking barefoot. Itchy rash in the form of 2-3 mm wide and several centimeters snake-like reddish tunnels, reflecting the travel of the parasite underneath the skin, usually develops on the foot, or other parts of the leg, or on the hands (Picture 2).

Treatment. To prevent itch and to kill parasites, anti-parasitic drugs, such as thiabendazole as ointment, or, in widespread lesions, by mouth can be used. With treatment, itch should resolve in a day, and skin lesions should heal in a week (2). Without treatment, lesions disappear in 4-8 weeks in most cases.

Prevention is in avoiding direct skin contact with soil and sand.

Tungiasis

In tungiasis, an itchy or painful 4-10 mm sized white rash with the black center appears on the foot. It is caused by burrowing flea Tunga penetrans (sandflea, bug of the foot) that lives in moist soil. It is usually contracted by walking barefoot in rural areas in India or South America. The rash naturally heals within 14 days. Treatment may include physical removal of the flea by the doctor, and anti-parasitic ointments, like thiabendazole.

Pitted Keratolysis

In pitted keratolysis, small shallow cavities appear in the upper layer of the soles or palms. They are common in people with excessive perspiration and may sometimes itch. Treatment, if necessary, is with OTC antibiotic ointments. Prevention is by keeping feet dry.

Sweaty Sock Syndrome (Juvenile Plantar Dermatosis)

Shiny, dry, reddish skin on the soles that may crack and cause pain or itch mostly affects children with atopic dermatitis. The exact cause is not known and there is no specific treatment. Friction of feet should be prevented by wearing well fitted shoes. Fissures should be allowed to heal by resting and covering with plasters. Feet should be regularly covered with ointments, like Vaseline, right after evening shower, and Dimeticone during the day. Condition usually resolves before onset of puberty.

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